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Kirabira J, Rukundo GZ, Zanoni BC, Obua C, Wakida E, Atala CE, Akello NE, Huang KY, Ashaba S. Healthcare workers' perspective about barriers and facilitators to pediatric HIV status disclosure in eastern Uganda using capability opportunity and motivation of behavior change model. PLOS GLOBAL PUBLIC HEALTH 2025; 5:e0004662. [PMID: 40440251 PMCID: PMC12121738 DOI: 10.1371/journal.pgph.0004662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 04/28/2025] [Indexed: 06/02/2025]
Abstract
HIV status disclosure by caregivers to children and adolescents living with HIV (CALH) remains a public health concern in countries with a high burden of HIV despite guidelines for healthcare workers (HCWs) to facilitate the process. This study explored barriers and facilitators to HIV disclosure at two referral hospitals in eastern Uganda focusing on the utilization of existing guidelines. In-depth qualitative interviews were conducted among all HCWs involved in the management of CALH at three pediatric HIV clinics. Research assistants collected data using a semi-structured interview guide designed based on the Capability, Opportunity, and Motivation of Behavior change (COM-B) Model. The audio-recorded interviews were transcribed verbatim, analyzed thematically, and categorized based on the COM-B and social-ecological models using the inductive content approach. Sixteen in-depth interviews were conducted among HCWs, including both males and females in equal numbers. The barriers to disclosure involved all five levels of the social-ecological model, while facilitators were at only three levels (individual, interpersonal, and institutional levels). Regarding the capability of HCWs to support disclosure, limited training affected their psychological (knowledge) and physical ability (skills), while awareness of responsibilities enhanced psychological ability. For opportunity, an unstable home environment, limited access to guidelines, and HIV-related stigma were barriers in physical and social environments, while peer support, teamwork, and orphanhood status were facilitators in the social environment. Limited health funding and lack of preparatory procedures affected reflective motivation, while delayed disclosure affected automatic motivation. Conversely, emotional reward and monitoring, checklists, and supervision enhanced the automatic motivation of HCWs toward disclosure. The findings highlighted several potentially modifiable factors that need to be addressed or reinforced to improve HIV disclosure and utilization of existing guidelines. These findings are key in informing stakeholders regarding the development of implementation strategies for improving pediatric HIV disclosure and utilization of existing guidelines in Uganda.
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Affiliation(s)
- Joseph Kirabira
- Department of Psychiatry, Busitema University, Mbale, Uganda
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian C. Zanoni
- Departments of Medicine and Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Celestino Obua
- Office of Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith Wakida
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christine Etoko Atala
- Department of Anaesthesia, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Keng-Yen Huang
- School of Medicine, New York University, New York, United States of America
| | - Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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Dibia CC, Nwaokoro P, Akpan U, Toyo O, Cartier S, Sanwo O, Sydney-Agbor N, Afirima B, Kakanfo K, Essien U, Walker CF, Khamofu H, Pandey SR, Bateganya M. Innovations in Providing HIV Index Testing Services: A Retrospective Evaluation of Partner Elicitation Models in Southern Nigeria. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2400013. [PMID: 39317450 PMCID: PMC11521547 DOI: 10.9745/ghsp-d-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024]
Abstract
Background: This analysis aimed to evaluate the effectiveness of eliciting sexual partners from HIV-positive clients using the elicitation box model (where an HIV-positive index can report sexual contacts on paper and insert in a box for a health care provider to contact at a later time) compared to the conventional model (in which a health care provider elicits sexual contacts directly from clients) in Akwa Ibom, Southern Nigeria.Methods: Between March 2021 and April 2022, data were collected from index testing registers at 4 health facilities with a high volume of HIV clients currently on treatment in 4 local government areas in Akwa Ibom State. Primary outcome analyzed was the elicitation ratio (number of partners elicited per HIV-index offered index testing services). Secondary outcomes were the index testing acceptance (index HIV-positive clients accepted index testing service), testing coverage (partners tested for HIV from a list of partners elicited from HIV-index accepted index testing services), testing yield (index partners identified HIV positive from index partners HIV-tested), and linkage rate (index partners identified HIV positive and linked to antiretroviral therapy).Results: Of the total 2,705 index clients offered index testing services, 91.9% accepted, with 2,043 and 439 indexes opting for conventional elicitation and elicitation box models, respectively. A total of 3,796 sexual contacts were elicited: 2,546 using the conventional model (elicitation ratio=1:1) and 1,250 using the elicitation box model (elicitation ratio=1:3). Testing coverage was significantly higher in the conventional compared to the elicitation box model (P<.001). However, there was no significant difference in the testing yield (P=.81) and linkage rate using the conventional compared to elicitation box models (P=.13).Conclusion: The implementation of the elicitation box model resulted in an increase in partner elicitation compared to the conventional model. Increasing the testing coverage by implementing the elicitation box model should be considered.
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Affiliation(s)
- Caesar C Dibia
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria.
| | - Pius Nwaokoro
- FHI 360, National Capital District, Papua New Guinea
| | - Uduak Akpan
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | - Otoyo Toyo
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | | | | | | | | | - Kunle Kakanfo
- African Hub for Health and Innovation, Ottawa, Canada
| | - Uwem Essien
- Centre for Integrated Health Programs, Kaduna, Nigeria
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Muessig KE, Vecchio AC, Hanshaw BD, Soberano Z, Knudtson KA, Claude KF, Larsen MA, Hightow-Weidman LB. Barriers, Facilitators and Opportunities for HIV Status Disclosure Among Young Men Who Have Sex With Men: Qualitative Findings from the Tough Talks Intervention. AIDS Behav 2024; 28:3283-3299. [PMID: 38951455 PMCID: PMC11427151 DOI: 10.1007/s10461-024-04406-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
Disclosing one's HIV status can involve complex individual and interpersonal processes interacting with discriminatory societal norms and institutionalized biases. To support disclosure decision-making among young men who have sex with men (YMSM) living with HIV, we developed Tough Talks™, an mHealth intervention that uses artificially intelligent-facilitated role-playing disclosure scenarios and informational activities that build disclosure skills and self-efficacy. Qualitative interviews were conducted with 30 YMSM living with HIV (mean age 24 years, 50% Black) who were enrolled in a randomized controlled trial assessing Tough Talks™ to understand their experiences with HIV status disclosure. Interviews were recorded, transcribed, and thematically coded. Barriers to disclosure focused on fear, anxiety, stigma, and trauma. Facilitators to disclosure are described in the context of these barriers including how participants built comfort and confidence in disclosure decisions and ways the Tough Talks™ intervention helped them. Participants' narratives identified meaning-making within disclosure conversations including opportunities for educating others and advocacy. Findings revealed ongoing challenges to HIV status disclosure among YMSM and a need for clinical providers and others to support disclosure decision-making and affirm individuals' autonomy over their decisions to disclose. Considering disclosure as a process rather than discrete events could inform future intervention approaches.
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Affiliation(s)
- Kathryn E Muessig
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA.
- University of North Carolina-Chapel Hill, Gillings School of Global Public Health Chapel Hill, Chapel Hill, USA.
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA.
| | - Alyssa C Vecchio
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
| | - Brady D Hanshaw
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Harvard Medical School, Harvard University, Boston, USA
| | - Zachary Soberano
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
| | - Kelly A Knudtson
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
| | - Kristina Felder Claude
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
| | | | - Lisa B Hightow-Weidman
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- University of North Carolina-Chapel Hill, Gillings School of Global Public Health Chapel Hill, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
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Healey LM, Markham SR, Templeton DJ, Rabie L, Smith AKJ. Stigma, support, and messaging for people recently diagnosed with HIV: a qualitative study. Sex Health 2024; 21:SH24045. [PMID: 39418245 DOI: 10.1071/sh24045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 10/03/2024] [Indexed: 10/19/2024]
Abstract
Background Despite advances in antiretroviral treatment and the message of undetectable equals untransmittable (U=U), there remain challenges related to stigma and quality of life for people living with HIV. This study aimed to understand the experiences of people recently diagnosed with HIV at a clinical service, to guide insights into how to improve care and support in the contemporary treatment era. Methods This qualitative study involved semi-structured interviews with individuals diagnosed with HIV between 2016 and 2021 at RPA Sexual Health service (a sexual health clinic in Sydney, Australia), or who were referred to the clinic directly after diagnosis. Participants were recruited through a short survey questionnaire between May 2022 and May 2023, and interviews were transcribed and analysed thematically. Results Fourteen participants were interviewed for the study, eight of whom were born outside of Australian or Aotearoa New Zealand. We found that diagnosis was still a shocking event requiring careful support; that there was ongoing stigma, shame, and reduced sexual confidence following diagnosis; and that beyond initial diagnosis, some people would benefit from ongoing support and education about key concepts regarding HIV treatment. Conclusion Our study suggests that HIV diagnosis remains disruptive, and sexual stigma is a key issue negatively impacting quality of life. Health providers can mitigate these issues by supporting the ongoing psychosocial needs of people with HIV in the early period of adjusting to HIV diagnosis, and referring to peer-based and other services. Initiating conversations about sex and dating and checking understandings of key health messages over time may promote improved care.
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Affiliation(s)
- Loretta M Healey
- Department of Sexual Health Medicine, Community Health, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Shirin R Markham
- Department of Sexual Health Medicine, Community Health, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - David J Templeton
- Department of Sexual Health Medicine, Community Health, Sydney Local Health District, Sydney, NSW 2050, Australia; and Sexual Assault Medical Service, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW 2050, Australia; and The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia; and Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | | | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia; and Australian Human Rights Institute, UNSW Sydney, Sydney, NSW 2052, Australia
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Pralat R, Anderson J, Burns F, Barber TJ. Asked to be a sperm donor: disclosure dilemmas of gay men living with HIV. CULTURE, HEALTH & SEXUALITY 2024; 26:997-1011. [PMID: 37982670 DOI: 10.1080/13691058.2023.2276804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023]
Abstract
Previous research has documented the various challenges people living with HIV face as they navigate intimate relationships, including what is often referred to as disclosure. In studies of gay, bisexual and other men who have sex with men, the issue of telling or not telling others about an HIV-positive status has been examined primarily in relation to communication with sexual partners, with few studies focusing on other aspects of intimacy. Drawing on interviews with gay men living with HIV, conducted in four clinics in London, this article explores the narratives of men who have been asked by female friends about the possibility of being a sperm donor. The narratives highlight layers of complexity which have received little attention, not only in research on HIV but also in studies of sperm donation and co-parenting. The article advances dialogue between these two largely separate bodies of work. Our data suggest that reluctance to share an HIV-positive status with others can be an important factor in deciding how to answer the 'sperm donor question'. Examining reproductive relationships of a specific kind - those based on friendships between women and gay men - the article develops the understanding of how secrecy about HIV shapes intimate lives.
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Affiliation(s)
- Robert Pralat
- Department of Sociology, University of Cambridge, Cambridge, UK
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jane Anderson
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Tristan J Barber
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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Tatham C. Life and love under criminalization: The experiences of people living with HIV in Canada. PLoS One 2024; 19:e0306894. [PMID: 39052618 PMCID: PMC11271884 DOI: 10.1371/journal.pone.0306894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
Based upon qualitative interviews with 54 women and men living with HIV across Ontario, Canada, this paper examines the impact of HIV criminalization on the sexual and romantic relationships of people living with HIV. This research highlights the navigation strategies people living with HIV create and employ to both navigate and protect themselves from the law. Through a thematic and intersectional analysis, this study shows how adoption of these strategies is unequal, with access to navigation strategies varying along lines of gender, race, and sexual orientation. As a result, women and racialized people living with HIV face more difficulties navigating the impact of the law. HIV criminalization in Canada fuels and validates HIV stigma and produces vulnerability both within and outside of the relationships of people living with HIV. This paper seeks to understand HIV criminalization from the perspective of those governed by the law, in hopes of producing knowledge which will contribute to legal reform, inform policy, and support the development of efficacious secondary prevention initiatives.
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Affiliation(s)
- Christopher Tatham
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
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Kim GS, Kim L, Lee S, Shim MS, Lee Y, Baek S. Factors associated with health-related quality of life among people living with HIV in South Korea: Tobit regression analysis. PLoS One 2024; 19:e0303568. [PMID: 38753733 PMCID: PMC11098325 DOI: 10.1371/journal.pone.0303568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 04/27/2024] [Indexed: 05/18/2024] Open
Abstract
This study investigated health-related quality of life and identified factors affecting it among people with the HIV in South Korea. A total of 243 people living with HIV participated in this cross-sectional survey. Data were collected from five hospitals between November 2021 and August 2022 using structured online questionnaires. Data were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, Spearman's rho analysis, and Tobit regression analysis because a significant ceiling effect was observed for the dependent variable. The mean score for the health-related quality of life was 75.74 ± 16.48. The significant factors that positively influence the health-related quality of life were "employment" (B = 4.57, p = .035), "not participating in the self-help group" (B = 6.10, p = .004), "higher self-efficacy for managing symptoms" (B = 1.32, p = .036), "higher self-efficacy for getting support/help" (B = 0.95, p = .035), and "higher self-efficacy for managing fatigue" (B = 2.80, p < .001) in the Tobit regression analysis. The results suggest that interventions to increase self-efficacy should involve developing programs and policies for people living with HIV. There is a need for efforts to provide healthcare services linked to employment support, as well as to establish a social environment in which they can work without stigma. Further, self-help groups could be utilized as intervention channels.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Layoung Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - SangA Lee
- Manning College of Nursing and Health Sciences, University of Massachusetts, Boston, Massachusetts, United States of America
| | - Mi-So Shim
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Youngjin Lee
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Seoyoung Baek
- College of Nursing, Yonsei University, Seoul, Republic of Korea
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Fisk-Hoffman RJ, Parisi CE, Siuluta N, Ding DD, Widmeyer M, Somboonwit C, Cook RL. Antiretroviral Therapy Concealment Behaviors and their Association with Antiretroviral Therapy Adherence among People with HIV: Findings from the Florida Cohort Study. AIDS Behav 2024; 28:1047-1057. [PMID: 37861924 PMCID: PMC10922241 DOI: 10.1007/s10461-023-04214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
Little is known about HIV medication concealment behaviors and the effect of medication concealment on antiretroviral therapy (ART) adherence among people with HIV (PWH). This study aims to (1) to describe medication concealment behaviors and factors associated with these behaviors, and (2) assess the association between medication concealment and suboptimal ART adherence. The Florida Cohort Study enrolled adult PWH from community-based clinics around the state from October 2020 to September 2022 (n = 416, 62% aged 50+, 56% male, 44% non-Hispanic Black, 18% Hispanic). Participants responded to questions about sociodemographics, stigma, ART adherence (≥ 85%), symptoms of depression, social networks and disclosure to their networks, and actions to conceal ART to avoid inadvertent disclosure of their HIV status. Analyses were conducted using multivariable logistic regressions models. The most common concealment behavior was hiding ART while having guests over (32%), followed by removing ART labels (26%), and putting ART into a different bottle (16%). Overall, 43% reported ≥ 1 behavior. In multivariable models, depressive symptoms, incomplete disclosure of HIV to close social networks, and not having a close social network were associated with ART concealment. After adjusting for risk factors for suboptimal ART adherence, endorsing hiding medication while having guests was associated with suboptimal ART adherence (aOR 2.87, 95% CI 1.15-7.55). Taking any action and other individual behaviors were not associated. ART concealment behaviors were common but did not consistently negatively influence adherence when accounting for other factors. PWH may want to receive ART medications in ways that ensure privacy and reduce the risk of inadvertent disclosure.
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Affiliation(s)
- Rebecca J Fisk-Hoffman
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christina E Parisi
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nanyangwe Siuluta
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Delaney D Ding
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Charurut Somboonwit
- Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA.
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Brown MJ, Trask JS, Kaur A, Li X. Association between sociodemographic characteristics and HIV disclosure among people living with HIV in South Carolina: a structural equation modeling approach. AIDS Care 2023; 35:1904-1910. [PMID: 36630703 PMCID: PMC10333445 DOI: 10.1080/09540121.2022.2163612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
HIV disclosure continues to be a key consideration among people living with HIV (PLWH). However, there is a lack of studies assessing factors associated with HIV disclosure among PLWH in the Southern U.S. Therefore, the aim of this study was to assess the association between sociodemographic risk factors and HIV disclosure using a structural equation modeling approach among PLWH in South Carolina. Exploratory factor analysis was used to operationalize HIV disclosure. Structural equation models were used to determine the associations between sociodemographic factors and HIV disclosure among PLWH. Two latent variables were obtained for HIV disclosure: partners (stable partners, spouses, casual partners), and family/friends (parents, grandparents, siblings, children, adult children, friends, and coworkers). After adjusting for confounders, Black populations were less likely to disclose their HIV status to both partners (β = -0.250, p = 0.006) and family/friends (β = -0.246, p < 0.001) compared to non-Black populations. As yearly income increased, the likelihood of HIV disclosure to family/friends decreased (β = -0.300, p = <0.001). As time since diagnosis increased, the likelihood of HIV disclosure to family/friends increased (β = 0.266, p = 0.001). Future research can assess the feasibility of implementing disclosure interventions that are geared towards Black, high income and newly diagnosed PLWH and the associations of psychosocial factors and HIV disclosure.
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - J. Stewart Trask
- Department of Biological Sciences, College of Arts and Sciences, University of South Carolina
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
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Bryant J, Smith AKJ, Persson A, Valentine K, Drysdale K, Wallace J, Hamilton M, Newman CE. Logics of control and self-management in narratives of people living with HIV, hepatitis C and hepatitis B. CULTURE, HEALTH & SEXUALITY 2023; 25:1214-1229. [PMID: 36476229 DOI: 10.1080/13691058.2022.2149858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
In Australia, the response to HIV, hepatitis C and hepatitis B has largely been through the constructed category of 'blood borne viruses' which treats these viruses as an interconnected set of conditions with respect to their mode of transmission. In this paper, we explore how people understand their viral infection, and compare the logics underpinning these different understandings. In-depth interviews were conducted with 61 participants who were either living with a blood borne virus or were the family members of people living with them. Our analysis reveals that the viral infection was often described as 'just a condition that needs to be managed', albeit in potentially exhausting ways. This understanding hinged upon a biomedical logic in which viral invasion was seen as causing illness and in turn necessitating biomedical intervention. In contrast, some participants with hepatitis B presented their infection as a condition unintelligible through Western biomedical logics, defined instead by symptomology - in terms of 'liver disease', and/or 'liver inflammation'. This focus on symptomology calls into question the soundness of prevention and management responses to hepatitis B based in biomedical logics and reveals the extent to which living with a virus involves multiple, sometimes incompatible, cultural logics. The different logics underpinning HIV, hepatitis C and hepatitis B reveal shortcomings of framing these viruses together as a coherent single construct.
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Affiliation(s)
- Joanne Bryant
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Asha Persson
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Myra Hamilton
- University of Sydney Business School, Sydney, NSW, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
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Wells N, Murphy D, Ellard J, Howard C, Keen P, Fairley C, Donovan B, Prestage G, on behalf of the RISE Study Team. Requesting HIV Results Be Conveyed in-Person: Perspectives of Clinicians and People Recently Diagnosed with HIV. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-8. [PMID: 37363348 PMCID: PMC10257370 DOI: 10.1007/s13178-023-00827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/28/2023]
Abstract
Introduction Guidelines recommend that, where possible, clinicians convey HIV-positive test results in person in Australia. However, HIV-negative and all other STI results are routinely delivered by phone or text message. Requesting individuals to obtain positive HIV test results in person could be a deviation from the standard delivery of healthcare and be interpreted as indicating a positive HIV diagnosis. Methods This paper is based on two related, ongoing qualitative studies conducted in Australia with HIV healthcare providers and people recently diagnosed with HIV. In study one, in-depth, semi-structured interviews were conducted with people who had recently received a positive HIV diagnosis. In study two, in-depth, semi-structured interviews were conducted with HIV healthcare and peer support providers. Interviews were analyzed thematically. Results While clinicians were willing to convey HIV-positive diagnoses by phone, most preferred in-person delivery. In-person delivery enabled clinicians to assess visual cues to better respond to the psychological and emotional needs of patients. For some participants living with HIV, however, the requirement to return to the clinic was interpreted as an unofficial HIV-positive diagnosis. This led to a period in which recently diagnosed participants believed they were HIV-positive without having received an explicit diagnosis. Conclusion Protocols for delivering HIV diagnoses by phone, followed by a face-to-face appointment, may reduce the period of anxiety for some patients and assist with an early connection to HIV care and support. Policy Implications In some instances, conveying HIV diagnoses by phone may be more appropriate than recalling individuals to the clinic to deliver a positive HIV diagnosis in person.
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Affiliation(s)
- Nathanael Wells
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Dean Murphy
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Jeanne Ellard
- Australian Research Centre for Sex, Health, and Society, Bundoora, Australia
| | - Chris Howard
- Queensland Positive People (QPP), Brisbane, Australia
- National Association for People With HIV Australia, Sydney, Australia
| | - Phillip Keen
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Christopher Fairley
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Basil Donovan
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Garrett Prestage
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - on behalf of the RISE Study Team
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
- Australian Research Centre for Sex, Health, and Society, Bundoora, Australia
- Queensland Positive People (QPP), Brisbane, Australia
- National Association for People With HIV Australia, Sydney, Australia
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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12
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Living experiences of people living with HIV-AIDS from the client's perspective in nurse-client interaction in Indonesia: A qualitative study. PLoS One 2023; 18:e0282049. [PMID: 36812224 PMCID: PMC9946244 DOI: 10.1371/journal.pone.0282049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Nurse-client interaction when providing nursing services is limited to optimizing treatment and self-care, with limited focus on the psychological problems of people living with HIV-AIDS. However, psychological problems manifest more often than the health risks of the disease itself. This study aimed to determine the emotional response of people living with HIV-AIDS who received limited attention from nurses from the perspective of nurse-client relationship. PATIENTS AND METHODS A phenomenological qualitative design was used through in-depth face-to-face interviews in a semi-structured manner, in an effort to obtain complete data. This research used purposive sampling with Participatory Interpretative Phenomenology analysis, involving 22 participants (14 males and 8 females). RESULTS This research produces several themes, with six subcategories: 1) Difficulty of social access, 2) Forcing to accept their situation and suppressing their will, 3) Wanting to be recognized like other people in general, 4) Social stigma and self-stigmatization affecting surroundings, 5) Lacking enthusiasm for life expectancy, 6) Always lingering under the shadow "when death picks up." CONCLUSION The results showed that mental stress was experienced more than physical problems by people living with HIV-AIDS, thus prompting new changes to nursing services for HIV-AIDS patients that emphasize psychosocial aspects, in addition to clinical features, facilitated by satisfying relationships between nurses and clients to provide quality services.
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13
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Wells N, Murphy D, Ellard J, Philpot SP, Prestage G. HIV Diagnosis as Both Biographical Disruption and Biographical Reinforcement: Experiences of HIV Diagnoses Among Recently Diagnosed People Living With HIV. QUALITATIVE HEALTH RESEARCH 2023; 33:165-175. [PMID: 36633974 DOI: 10.1177/10497323221146467] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Despite the potential for HIV treatments to transform the health needs of people living with HIV, receiving a positive HIV diagnosis can be a difficult experience and feelings of shock, distress and concerns for the future are commonly reported. Drawing on Michael Bury's conceptualisation of 'biographical disruption', we utilised semi-structured interviews to explore experiences of HIV diagnoses among 34 people diagnosed with HIV between 2016 and 2020 and living in Australia. Interviews were conducted between January 2018 and August 2021. Despite significant advances in biomedical HIV treatments and prevention, participants commonly experienced HIV diagnosis as emotionally challenging. For those with limited HIV awareness, HIV was commonly understood as a likely fatal condition. For some participants, receiving a positive diagnosis also engendered a degree of uncertainty as to their anticipated life trajectory, particularly its impact on future sexual and romantic relationships, options for starting a family and migration opportunities. For some gay and bisexual male participants, receiving a positive diagnosis almost confirmed a life trajectory that they had worked to avoid and their own sometimes-negative attitudes toward people living with HIV were internalised, making adjusting to diagnosis more complex. While all participants reported challenges in adjusting to an HIV diagnosis, some ultimately came to experience living with HIV as bringing about unexpected and welcome changes to their lives. Our findings highlight the complex and intersecting medical, social and emotional needs of people living with HIV when receiving and adjusting to a positive HIV diagnosis.
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Affiliation(s)
- Nathanael Wells
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Dean Murphy
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Jeanne Ellard
- 110434Australian Research Centre in Sex, Health, and Society, Melbourne, VIC, Australia
| | - Steven P Philpot
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Garrett Prestage
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
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14
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Marcus U, Jonas K, Berg R, Veras MA, Caceres CF, Casabona J, Schink SB, Schmidt AJ. Association of internalised homonegativity with partner notification after diagnosis of syphilis or gonorrhoea among men having sex with men in 49 countries across four continents. BMC Public Health 2023; 23:8. [PMID: 36597057 PMCID: PMC9809117 DOI: 10.1186/s12889-022-14891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Partner notification (PN) after a sexually transmitted infection (STI) diagnosis is being promoted as a means to interrupt transmission chains. We investigated whether Internalised Homonegativity (IH) is associated with PN among men having sex with men (MSM). METHODS PN, defined as notifying at least one partner after diagnosis of syphilis and gonorrhoea, was queried in two internet-based self-completion surveys conducted between Oct 2017 and May 2018 in 68 countries in Europe, Latin America, Canada, and the Philippines. IH is defined by a man's level of agreement or disagreement with negative social beliefs about male homosexuality. Covariates included in a multivariate regression model with a random intercept at country level were age, HIV diagnosis, partnership status, sexual self-efficacy, HIV serostatus communication during last sex with a non-steady partner, place where this partner was met, and PN-related socio-historical background of the country of residence. We grouped countries in three areas: North- and Central-Western European countries plus Canada, former socialist countries, and Latin-American/Mediterranean countries plus the Philippines. In each of the three areas individuals were assigned to 4 subgroups based on IH quartiles and PN rates were determined for each subgroup. RESULTS PN rates were calculated for 49 countries (excluding countries with less than 10 diagnoses). Mean proportions of MSM notifying their partners were 68.1% and 72.9% after syphilis and gonorrhoea diagnoses, respectively. PN rates were lower in Latin American countries and the Philippines compared to European countries. Within Europe, a North-South divide with lower PN rates in Mediterranean countries was observed. In each of the three regions we mostly observed a stepwise increase of PN rates with decreasing IH. Regression analysis showed lower IH scores associated with higher PN rates. Higher perceived self-efficacy, living in a partnership, and HIV status communication were positively associated with PN. Men who had met their last partner in a gay social venue were more likely to have notified their partners of a syphilis diagnosis compared to men who had met this partner online. Men with diagnosed HIV were less likely to report PN. CONCLUSIONS We could demonstrate that IH was associated with PN among MSM across all countries included in our analysis. Reducing cultural homophobia and ensuring inclusive policies may contribute to STI prevention and control.
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Affiliation(s)
- Ulrich Marcus
- grid.13652.330000 0001 0940 3744Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Kai Jonas
- grid.5012.60000 0001 0481 6099Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rigmor Berg
- grid.418193.60000 0001 1541 4204Division for the Health Services, Norwegian Institute of Public Health, Oslo, Norway ,grid.10919.300000000122595234Department of Community Medicine, University of Tromso, Tromso, Norway
| | - Maria Amelia Veras
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr Cesario Mota Jr 61, São Paulo, SP 01221-020 Brazil
| | - Carlos F. Caceres
- grid.11100.310000 0001 0673 9488Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jordi Casabona
- Health Department, Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Generalitat de Catalunya, Badalona, Spain ,grid.429186.00000 0004 1756 6852Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Susanne B. Schink
- grid.13652.330000 0001 0940 3744Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Axel J. Schmidt
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, Sigma Research, London, UK
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15
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Ramos-Vera C, Basauri-Delgado M, Diaz Peña M, Tinoco Alberto J, Perez Arroyo K, Herrera Mamani B, Sánchez-Villena A, Saintila J. Bifactor SEM and MIRT Structure of a 12-Item Human Immunodeficiency Virus Stigma Scale in Peruvian Adults. J Prim Care Community Health 2023; 14:21501319231197589. [PMID: 37750178 PMCID: PMC10521262 DOI: 10.1177/21501319231197589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The stigma associated with human immunodeficiency virus (HIV) can lead to prejudice and discrimination against people who have been infected by this virus, consequently, it is important to have a validated tool to measure this phenomenon. However, there is only 1 national precedent that has validated the scores of this instrument in its 21-item version. Therefore, this study examined the bifactor structural equation method (SEM) and multidimensional item response theory (MIRT) structure of a 12-item human immunodeficiency virus stigma scale in Peruvian adults. METHODS We evaluated 342 patients (57.6% female and 42.45% male) diagnosed with HIV receiving highly active antiretroviral therapy (HAART) from a hospital located in East Lima, aged 18 to 45 years (M = 31.4, SD = 9.79). A SEM was used to test 2 measurement models, a 4-factor correlated oblique model and a bifactor model due to high interfactor relationships. RESULTS Acceptable fit indices were identified for the oblique model (χ2/df = 1.26, SRMR = 0.044, RMSEA [90% CI] = 0.028 [0.000-0.047], CFI = 0.996, TLI = 0.994). In the same way, similar results were evident for the bifactor model (χ2/df = 1.14, SRMR = 0.039, RMSEA [90% CI] = 0.020 [0.000-0.044], CFI = 0.998, TLI = 0.997), however, in the latter it showed a greater explanation for the unidimensional model (H = 0.87, PUC = 0.82, LCA = 0.70), which was also evidenced by the bifactor MIRT analysis. CONCLUSION It is concluded that the 12-item HIV Stigma Scale meets the psychometric properties of internal structure and unifactorial reliability.
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Quality of Life of People Living with HIV in Australia: The Role of Stigma, Social Disconnection and Mental Health. AIDS Behav 2023; 27:545-557. [PMID: 35831492 PMCID: PMC9281266 DOI: 10.1007/s10461-022-03790-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/05/2022]
Abstract
HIV is a manageable chronic illness, due to advances in biomedical management. However, many people living with HIV (PLHIV) continue to experience psychosocial challenges, which have been associated with poorer quality of life (QoL). This study aimed to explore how psychosocial factors contributed to the QoL of PLHIV in Australia; specifically, the relationship between HIV-related stigma, social connectedness, mental health, and QoL. Participants were 122 PLHIV attending The Albion Centre (a tertiary HIV clinic in Sydney, Australia), who completed questionnaires which measured HIV-related stigma, social support, mental health symptomology and QoL. Results indicated that HIV-related stigma predicted poorer QoL, as did mental health symptomology. Conversely, social connectedness improved QoL. Additionally, social connectedness was found to mediate the relationship between HIV-related stigma and QoL, whereas the hypothesized moderating role of mental health symptomology on this model was not significant. These findings provide insight into the impact of psychosocial factors on QoL, offering practitioners various points of clinical intervention.
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Wells N, Philpot SP, Murphy D, Ellard J, Howard C, Rule J, Fairley C, Prestage G. Belonging, social connection and non-clinical care: Experiences of HIV peer support among recently diagnosed people living with HIV in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4793-e4801. [PMID: 35717630 PMCID: PMC10946990 DOI: 10.1111/hsc.13886] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/08/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Effective HIV treatments have transformed the medical needs of people living with HIV (PLHIV) to a chronic condition. However, stigma, poorer mental health outcomes and social isolation remain significant challenges for many PLHIV. HIV peer support programs have assisted PLHIV in navigating the clinical, emotional and social aspects of living with HIV. We draw on semi-structured interviews with 26 recently diagnosed PLHIV in Australia to explore experiences of HIV peer support services. Our thematic analysis identified three overarching themes. First, participants commonly reported that peer support programs offered a sense of belonging and connection to a broader HIV community. This established a network, sometimes separate to their existing social networks, of other PLHIV with whom to share experiences of HIV. Second, peer-based programs provided an opportunity for participants to hear firsthand, non-clinical perspectives on living with HIV. While participants valued the clinical care they received, the perspectives of peers gave participants insights into how others had managed aspects of living with HIV such as disclosure, sex and relationships. Finally, participants highlighted important considerations around ensuring referrals were made to socially and culturally appropriate support programs. Peer support programs fill an important gap in HIV care, working alongside and extending the work of the clinical management of HIV. Incorporating formal referrals to peer support services as part of the HIV diagnosis process could assist recently diagnosed PLHIV in adjusting to a positive diagnosis.
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Affiliation(s)
- Nathanael Wells
- Kirby InstituteUNSW SydneyKensingtonNew South WalesAustralia
| | | | - Dean Murphy
- Kirby InstituteUNSW SydneyKensingtonNew South WalesAustralia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Chris Howard
- Queensland Positive People (QPP)East BrisbaneQueenslandAustralia
| | - John Rule
- National Association of People with HIV AustraliaNewtownNew South WalesAustralia
| | - Christopher Fairley
- Melbourne Sexual Health CentreMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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18
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Philpot SP, Aung E, Templeton DJ, Stackpool G, Varma R, Power C, Robinson S, Stratigos A, Mao L, Grulich AE, Bavinton BR. Experiences of recently HIV-diagnosed gay and bisexual migrants in Australia: Implications for sexual health programmes and health promotion. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5801-e5810. [PMID: 36107017 PMCID: PMC10087732 DOI: 10.1111/hsc.14011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/22/2022] [Accepted: 08/20/2022] [Indexed: 05/24/2023]
Abstract
Gay and bisexual migrants from low- and middle-income countries living in high-income countries are disproportionately diagnosed with HIV. Most research focuses on preventing HIV acquisition among HIV-negative migrant gay and bisexual men (GBM). This study is uniquely positioned to report on migrant GBM's experiences and needs at and after an HIV diagnosis. Semi-structured interviews were conducted with 24 migrant GBM diagnosed at sexual health clinics in Australia from 2017 onwards. Interviews were analysed using a codebook thematic analysis. Due to the stigma of HIV and homosexuality in their countries of origin, about half of participants had poor HIV knowledge prior to diagnosis. Absorbing diagnosis information was consequently difficult, and feelings of shame, hopelessness, lost sexual opportunities and infectiousness were common. However, many were thankful for the comprehensive clinical support they received and believed that over time life would 'normalise' with sustained undetectable viral load. None reported that their clinician stigmatised them, but the anticipation of stigma nonetheless infused their experiences after diagnosis. Many were selective about HIV disclosure, and some mentioned that clinic systems posed a risk to confidentiality. Non-permanent residents were concerned about the impacts of HIV status on future visa applications. We recommend that newly HIV-diagnosed migrant GBM receive referral to legal and culturally appropriate migration services to help absorb what a diagnosis might mean for their health and visa status. We also recommend sexual health clinics continue to assess confidentiality in their systems. Health promotion initiatives should highlight to migrant GBM that high-HIV caseload sexual health clinicians provide confidential and comprehensive care.
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Affiliation(s)
| | - Eithandee Aung
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - David J. Templeton
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Department of Sexual Health Medicine and Sexual Assault Medical ServicesSydney Local Health DistrictSydneyAustralia
- Discipline of Medicine, Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
| | - Gai Stackpool
- Multicultural HIV and Hepatitis ServiceDiversity Programs and Strategy Hub, Population Health, Sydney Local Health DistrictSydneyAustralia
| | - Rick Varma
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Sydney Sexual Health Centre, Population and Community HealthSouth Eastern Sydney Local Health DistrictSydneyAustralia
| | | | - Sharon Robinson
- Department of Infectious Diseases, Immunology and Sexual HealthSt George HospitalSydneyAustralia
- St George and Sutherland Clinical SchoolUNSW SydneySydneyNew South WalesAustralia
| | | | - Limin Mao
- Centre for Social Research in HealthUNSW SydneyNew South WalesSydneyAustralia
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Mendonca CJ, Newton-John TRO, Bulsara SM. Psychosocial factors and quality of life in HIV. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2059338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Carley J. Mendonca
- Clinical Psychology, Graduate School of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Toby R. O. Newton-John
- Clinical Psychology, Graduate School of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Shiraze M. Bulsara
- Clinical Psychology, Graduate School of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
- Psychology Unit, The Albion Centre, Surry Hills, NSW, Australia
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20
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Sturt J. Shame in younger adults with a type 2 diabetes diagnosis: Where might this be leading? Diabet Med 2022; 39:e14693. [PMID: 34545954 DOI: 10.1111/dme.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
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Wanjala SW, Too EK, Luchters S, Abubakar A. Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13074. [PMID: 34948690 PMCID: PMC8701211 DOI: 10.3390/ijerph182413074] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Addressing HIV-related stigma requires the use of psychometrically sound measures. However, despite the Berger HIV stigma scale (HSS) being among the most widely used measures for assessing HIV-related stigma, no study has systematically summarised its psychometric properties. This review investigated the psychometric properties of the HSS. A systematic review of articles published between 2001 and August 2021 was undertaken (CRD42020220305) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, we searched the grey literature and screened the reference lists of the included studies. Of the total 1241 studies that were screened, 166 were included in the review, of which 24 were development and/or validation studies. The rest were observational or experimental studies. All the studies except two reported some aspect of the scale's reliability. The reported internal consistency ranged from acceptable to excellent (Cronbach's alpha ≥ 0.70) in 93.2% of the studies. Only eight studies reported test-retest reliability, and the reported reliability was adequate, except for one study. Only 36 studies assessed and established the HSS's validity. The HSS appears to be a reliable and valid measure of HIV-related stigma. However, the validity evidence came from only 36 studies, most of which were conducted in North America and Europe. Consequently, more validation work is necessary for more precise insights.
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Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Department of Social Sciences, Pwani University, Kilifi P.O. Box 195-80108, Kenya
| | - Ezra K. Too
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
| | - Stanley Luchters
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Public Health, Pwani University, Kilifi P.O. Box 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi P.O. Box 230-80108, Kenya
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Jahun I, Dirlikov E, Odafe S, Yakubu A, Boyd AT, Bachanas P, Nzelu C, Aliyu G, Ellerbrock T, Swaminathan M. Ensuring Optimal Community HIV Testing Services in Nigeria Using an Enhanced Community Case-Finding Package (ECCP), October 2019-March 2020: Acceleration to HIV Epidemic Control. HIV AIDS (Auckl) 2021; 13:839-850. [PMID: 34471388 PMCID: PMC8403567 DOI: 10.2147/hiv.s316480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/19/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed Nigeria’s progress toward the UNAIDS 90-90-90 targets: 47% of HIV-positive individuals knew their status; of these, 96% were receiving antiretroviral therapy (ART); and of these, 81% were virally suppressed. To improve identification of HIV-positive individuals, Nigeria developed an Enhanced Community Case-Finding Package (ECCP). We describe ECCP implementation in nine states and assess its effect. Methods ECCP included four core strategies (small area estimation [SAE] of people living with HIV [PLHIV], map of HIV-positive patients by residence, HIV risk-screening tool [HRST], and index testing [IT]) and four supportive strategies (alternative healthcare outlets, performance-based incentives for field testers, Project Extension for Community Healthcare Outcomes, and interactive dashboards). ECCP was deployed in nine of 10 states prioritized for ART scale-up. Weekly program data (October 2019–March 2020) were tracked and analyzed. Results Of the total 774 LGAs in Nigeria, using SAE, 103 (13.3%) high-burden LGAs were identified, in which 2605 (28.0%) out of 9,294 hotspots were prioritized by mapping newly identified PLHIV by residential addresses. Over 22 weeks, among 882,449 individuals screened using HRST, 723,993 (82.0%) were eligible and tested for HIV (state range, 43.7–90.4%), out of which 20,616 were positive. Through IT, an additional 3,724 PLHIV were identified. In total, 24,340 PLHIV were identified and 97.4% were linked to life-saving antiretroviral therapy. The number of newly identified PLHIV increased 17-fold over 22 weeks (week 1: 89; week 22: 1,632). Overall mean HIV positivity rate by state was 3.3% (range, 1.8–6.4%). Conclusion Using ECCP in nine states in Nigeria increased the number of PLHIV in the community who knew their status, allowing them to access life-saving care and decreasing the risk of HIV transmission.
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Affiliation(s)
- Ibrahim Jahun
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria
| | - Emilio Dirlikov
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA
| | - Solomon Odafe
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria
| | - Aminu Yakubu
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria
| | - Andrew T Boyd
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA
| | - Pamela Bachanas
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA
| | | | - Gambo Aliyu
- National Agency for the Control of AIDS (NACA), Abuja, Federal Capital Territory, Nigeria
| | - Tedd Ellerbrock
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA
| | - Mahesh Swaminathan
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria
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Campbell CK. Emotions and emotion work before, during and after HIV disclosure among Black gay and bisexual men living with HIV. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1739-1753. [PMID: 34519363 PMCID: PMC8688201 DOI: 10.1111/1467-9566.13372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
In the United States, Black gay and bisexual men account for a quarter of HIV infections and face intersecting social and structural stigmas along the axes of race, sexuality and class. For those diagnosed with HIV, these inequities shape their lived experiences which include HIV disclosure. Public health has privileged HIV status disclosure as the appropriate moral and responsible choice to protect sex partners, reduce stigma and obtain social support. Though little is known about the emotional aspects of HIV disclosure for Black gay and bisexual men, or how they are shaped by social and structural contexts. Using the frameworks of healthism and emotion work, I explore HIV disclosure among a sample of 30 Black gay and bisexual men living with HIV in the Deep South. Drawing on in-depth, qualitative interviews, I identify the emotion work that men engaged in to manage their own emotions and protect the emotions of others before, during and after disclosure or nondisclosure. These findings challenge public health research that has explored disclosure as discrete measurable events by illustrating how HIV disclosure is embedded in ongoing social and structural relations and provide insights that can guide new approaches focused on structural inequities that constitute HIV disclosure.
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Affiliation(s)
- Chadwick K Campbell
- Center for AIDS Prevention Research, University of California San Francisco, Francisco, California, USA
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Wu H, Wen‐Wei Ku S, Chang HH, Li C, Ko N, Strong C. Imperfect adherence in real life: a prevention-effective perspective on adherence to daily and event-driven HIV pre-exposure prophylaxis among men who have sex with men - a prospective cohort study in Taiwan. J Int AIDS Soc 2021; 24:e25733. [PMID: 34018330 PMCID: PMC8138098 DOI: 10.1002/jia2.25733] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Both daily and event-driven (ED) pre-exposure prophylaxis (PrEP) have been demonstrated to be highly effective among men who have sex with men (MSM). Prevention-effective adherence proposes that PrEP adherence should be aligned with the risk of HIV, which could be applied to both daily and ED PrEP adherence measurement. The objective of this study was to describe the relationship between the use of PrEP and sex events among the MSM PrEP users and identify factors associated with adherence among daily and ED MSM PrEP users. METHODS A multicentre, observational, prospective cohort study was conducted at three hospital-based clinics in three urban cities of Taiwan from January 2018 to December 2019. MSM ages 18 years or older - at high risk of HIV acquisition and taking PrEP during the study period - were included in the analysis. MSM PrEP users were allowed to choose between daily and ED PrEP based on their preference. Data on sociodemographic characteristics, mental health, sexual behaviours, substance use and PrEP-taking behaviours were collected at each visit. RESULTS A total of 374 MSM were included in the analysis with 1,054 visits. More than half (56%) of the PrEP users chose ED at the baseline and 150 regimen switches were reported by 21% of the participants. There was only one seroconversion documented during the study period. Most (84.2%) of the MSM PrEP users were able to adhere to PrEP during the most recent anal intercourse in the past one month. Among ED PrEP users with suboptimal adherence, the majority (81.9%) missed the pre-coital dose. In the multivariable analysis, we found that participants who switched from daily to an ED dosing regimen were associated with poorer adherence to PrEP. CONCLUSIONS A high level of PrEP adherence was observed among the majority of MSM in a real-world setting. On the other hand, Taiwanese MSM switching from daily to ED dosing regimens were less likely to adhere to PrEP, suggesting that novel approaches focusing on a dosing switch would be necessary for MSM to improve their adherence to PrEP.
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Affiliation(s)
- Huei‐Jiuan Wu
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- The Kirby InstituteUNSW SydneyNew South WalesAustralia
| | - Stephane Wen‐Wei Ku
- Division of Infectious DiseasesDepartment of MedicineTaipei Veterans General HospitalTaiwan
- Division of Infectious DiseasesDepartment of MedicineTaipei City Hospital Renai BranchTaiwan
| | - Howard H. Chang
- Department of Biostatistics and BioinformaticsEmory UniversityAtlantaGAUSA
| | - Chia‐Wen Li
- Division of Infectious DiseasesDepartment of Internal MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Nai‐Ying Ko
- Department of NursingCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Carol Strong
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
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Vermandere H, Aguilera-Mijares S, Martínez-Vargas L, Colchero MA, Bautista-Arredondo S. Developing HIV assisted partner notification services tailored to Mexican key populations: a qualitative approach. BMC Public Health 2021; 21:555. [PMID: 33743651 PMCID: PMC7981994 DOI: 10.1186/s12889-021-10612-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Assisted partner notification services (APNS) may increase HIV testing, early diagnosis, and treatment, but they are not formally implemented in Mexico, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transwomen (TW). This study aimed to explore the awareness of and need for HIV partner notification, as well as to outline potential strategies for APNS based on identified barriers and facilitators. Methods We conducted semi-structured interviews to explore partner notification with MSM, TW, and counselors. Afterwards, brainstorm sessions were carried out to produce strategies for implementing APNS. Results Most participants reported experiences with informal partner notification and serostatus disclosure, but not with APNS. Only one counselor indicated assisting notification systematically. The main barriers for notifying or disclosing mentioned by both MSM and TW included fear of (violent) reactions, discrimination and lacking contact information of casual partners. Participants thought it was easier to inform a formal partner, conditional of being well informed about HIV. Given current stigma and lack of awareness, it was suggested that APNS should be preceded by HIV awareness efforts, and be provided by counselors or peers to mitigate potential rejection or violent reactions. Conclusions While APNS are not formally implemented in Mexico, all participants supported the service, indicating that APNS could potentially enhance early HIV diagnosis in Mexico. Strategies to implement such services need to be flexible addressing the individual needs of participants, guaranteeing the safety of more vulnerable participants. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10612-3.
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Affiliation(s)
- Heleen Vermandere
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Santiago Aguilera-Mijares
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Liliane Martínez-Vargas
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - M Arantxa Colchero
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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Phillips TR, Medland N, Chow EPF, Maddaford K, Wigan R, Fairley CK, Ong JJ, Bilardi JE. "Moving from one environment to another, it doesn't automatically change everything". Exploring the transnational experience of Asian-born gay and bisexual men who have sex with men newly arrived in Australia. PLoS One 2020; 15:e0242788. [PMID: 33216802 PMCID: PMC7678978 DOI: 10.1371/journal.pone.0242788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/10/2020] [Indexed: 12/02/2022] Open
Abstract
Asian-born gay, bisexual and other men who have sex with men (gbMSM) who are newly arrived in Australia are at a higher risk of acquiring HIV than Australian-born gbMSM. We used a social constructionist framework to explore HIV knowledge and prevention strategies used by newly-arrived Asian-born gbMSM. Twenty four Asian-born gbMSM, aged 20–34 years, attending Melbourne Sexual Health Centre, who arrived in Australia in the preceding five years, participated in semi-structured, face-to-face interviews. Interviews were recorded, transcribed verbatim and analysed thematically. Participants described hiding their sexual identities in their country of origin, particularly from family members, due to fear of judgement and discrimination resulting from exposure to sexual identity and HIV related stigma in their countries of origin, although some were open to friends. Despite feeling more sexual freedom and acceptance in Australia, many were still not forthcoming with their sexual identity due to internalised feelings of stigma and shame. Exposure to stigma in their country of origin led many to report anxiety around HIV testing in Australia due to a fear of testing positive. Some described experiencing racism and lack of acceptance in the gay community in Australia, particularly on dating apps. Fear of discrimination and judgement about their sexual identity can have a significant impact on Asian-born gbMSM living in Australia, particularly in terms of social connectedness. Additionally, HIV-related stigma can contribute to anxieties around HIV testing. Our data highlights the potential discrimination Asian-born gbMSM face in Australia, which has implications for social connectedness, particularly with regard to LGBTQI communities and HIV testing practices. Future studies should determine effective strategies to reduce sexual identity and HIV-related stigma in newly-arrived Asian-born gbMSM.
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Affiliation(s)
- Tiffany R. Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- * E-mail:
| | - Nicholas Medland
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jade E. Bilardi
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, VIC, Australia
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Lim JM, Tan RKJ, Chan JKW. "Do I need to or do I want to?" A typology of HIV status disclosure among gay, bisexual, and other men who have sex with men. AIDS Care 2020; 32:142-147. [PMID: 32192368 DOI: 10.1080/09540121.2020.1742865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) are a key population that is disproportionately affected by HIV. However, few studies have explored how and why disclosure of HIV status occurs in this population. To understand disclosure in the context of other socioecological factors, we conducted a qualitative study among 24 self-identified HIV-positive GBMSM, aged 21 and above, and who were Singaporean residents. Analysis of participants' interviews revealed that disclosure of HIV status was not a binary event; rather, each type of disclosure held varying degrees of positive and negative ramifications. Disclosure and self-acknowledgement of HIV status at each time point also had different consequences for participants' quality of life. Suggested potential interventions include increasing training for medical professionals and public awareness surrounding issues relating to HIV. Findings from this study provide a framework to describe the complexities that accompany serostatus disclosure in a setting where there are prevalent "shame-based", negative attitudes towards HIV. As such, this framework can also be utilized in the future planning and organization of services for this target population in similar contexts.
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Affiliation(s)
- Jane Mingjie Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore
| | - Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore
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